Directional atherectomy of aorto-ostial stenoses

Balloon angioplasty of aorto-ostial right coronary artery (RCA) and aorto-ostial saphenous vein graft (SVG) stenoses has been reported to be associated with a suboptimal acute success rate, a higher incidence of restenosis and an increased risk of emergent coronary artery bypass surgery. In this report, we describe the use of directional coronary atherectomy (DCA) as a treatment alternative in a series of twenty three patients who were documented to have a > 60% stenosis within 3 mm of the origin of the RCA (15 patients) or SVG (8 patients) as measured by on-line quantitative angiography. DCA was successfully performed in 14 of 15 RCA ostial lesions and in all eight SVG lesions. This yielded an acute success rate of 93% and 100% with a mean reduction in percent stenosis from 87% to 9% and from 85% to 8% respectively. Only one patient, presenting with an ostial RCA lesion, was unable to be revascularized using DCA. All successfully treated patients underwent exercise treadmill testing or repeat cardiac catheterization in follow-up. Clinical evidence of restenosis defined as recurrent chest pain or ischemic evidence on exercise treadmill and > 50% angiographic restenosis was demonstrated in three of twenty two patients (14%). Of the nine successfully treated patients who underwent repeat cardiac catheterization, three (33%) had restenosed for an angiographic rate of 25% for RCA and 50% for SVG lesions. In conclusion, DCA of aorto-ostial stenoses is technically feasible and can be performed with good initial results.(ABSTRACT TRUNCATED AT 250 WORDS)